MEDICARE: MS. JENNY LYN L LEDESMA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	106H00000X	Marriage & Family Therapist	MI0348	NV

General Provider Information

NPI Number	:	1316206758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNY LYN L LEDESMA LMFT

Provider Business Mailing Address
First Line	:	6885 PAINTED MORNING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-3645
Country	:	US
Telephone Number	:	702-300-5128
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 W CRAIG RD STE D
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5121
Country	:	US
Telephone Number	:	702-300-5128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	04/05/2024

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